Purpose
To evaluate the difference of clinical and radiologic outcomes between Luschka’s joint preservation vs. total uncinatectomy in anterior cervical microforaminotomy.
Materials and Methods
From Dec. 2006 to Feb. 2012, 37 patients suffered unilateral cervical radiculopathy due to cervical foraminal disc herniation or spondylotic cervical stenosis underwent anterior cervical microforaminotomy in our hospital. The mean age of patients was 52.9 (range 35 to 72). 27 were men and 10 were women. 19 patients received total uncinatectomy and the other 18 patients received partial uncinatectomy. There was no difference in statistical significance for demographic factors between two groups. Clinical outcomes have been evaluated based on preoperative and postoperative VAS scores for axial pain and radicular pain described on medical records and classified according to modified Odom’s criteria. Postoperative radiologic evaluation was performed through follow up CT, MRI and plain films. Through this serial studies, postoperative degenerative change was evaluated.
Results
Mean follow up period was 44.6 months (from 12 month to 86 months). 6 of 19 patients from total uncinatectomy group suffered chronic postoperative axial neck pain lasting over 3 months after the surgery. In contrast, only 2 of 18 patients in the partial uncinatectomy group complained chronic neck pain. One patient of the partial uncinatectomy group underwent revision surgery due to incomplete decompression. The revision surgical modality was ACDF. Surgical result was classified according to modified Odom’s criteria. But, there was no statistical differences between outcomes of two groups. During the follow up period, degenerative change was observed in 10 of 19 patients in total uncinatectomy group and 7 of 18 patients in partial uncinatectomy group. But, there was no statistical differences, either (by Kaplan-Meier).
Conclusions
Anterior cervical microforaminotomy for unilateral cervical radiculopathy showed favorable results regardless of pathologic lesions, such as disc herniation or stenosis. Total uncinatectomy group seems to cause postoperative chronic axial neck pain, but there was no statistical significance. Anterior cervical microforaminotomy causes early degenerative changes of involved segment. There was no difference in development of degenerative changes between total uncinatectomy group and partial uncinatectomy group

Purpose
The purpose of this study was to determine the early failure rate of percutaneous epidural neuroplasty (PEN) that led to subsequent decompressive lumbar surgery. We also assessed the limits of spinal pain management by using the current PEN technique.
Materials and Methods
We classified 1763 cases according to their diagnoses and radiological findings. Patients who underwent subsequent open surgery when PEN failed to improve or aggravated their symptoms were included.
Results
All 37 patients underwent open decompressive surgery within 3 months after PEN. There were 18 in the intracanalicular focal herniation category, 11 in intracanalicular broad based herniation category, and 8 in foraminal category; the early failure rates were 1.7%, 1.9%, and 5.6%, respectively. There was no significant statistical difference between the intracanalicular categories with regard to failure rate, but the foraminal category had a higher rate of failure than that of intracanalicular categories (p<0.05). Moreover, there were 11 cases in intracanalicular categories that experienced deterioration or new symptoms due to posterior longitudinal ligament rupture or fragment migration. Among these, there were 9 cases (82%) with preexisting intracanalicular migrating fragments.
Conclusion
PEN with targeted drug delivery may be an effective treatment for low back pain and/or radiculopathy. However, its early failure rate is at least 2.1%, and the presence of intracanalicular migrating fragments or symptomatic foraminal lesions are predictors of poor outcome. Patients must be carefully selected on the basis of thorough radiologic reviews to improve the rate of satisfactory PEN outcomes.